HomeMy WebLinkAboutMortgage_Bazer (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ii
j;' 'i State Form 43709(R13/10-15) r
Presabed by Department of Local Government Finance /' ' _ it ■I':
INSTRUCTIONS: •. ark
To be filed in person or by mail. APR 1 9 2018 Form filed with:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought \,�
Must be filed or postmarked with the County Auditor or County Recorder of the county -�j e property is MI County Auditor
located on or before January 5 of the immediately succeeding calendar year. /❑ County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the X69..tr^'1'�%7t)
where t h e p r o p e r t y i s located d u r i n g t h e t w e l v e(12)months b e f o r e M a r c h 31 of e a c h year t h e•-•. ..' kr tT
See reverse side fora additional iinnssheuctions and qualifications. OR
Applicant( contra [.i on side)
- is-Ott Ke)' /legal piton Retard number Page number
, �' is-i /ate—coat. 592 oaf a°/01 as At
Assessed ratite of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment dale,arrant year date of application legal or equitable owner?
❑ Yes ❑ No
It no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate belowr. Is
property in question:Annually Assessed
Real Property ❑ AnnuaiyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller elta nr7`i
Address of mortgagee or contract seller(number and street cliwthate,and ZIP code)
1 .nor car assianee or other owner or holder of itiu gage
—o2 -i° • /7,99,- 4o/a - a Fa r . 1 / 4
Drawer NO..... )
............ ..
Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
CSII U NO• current year?. ❑Yes- Ill No
n has a balance on the person's mortgage or contract indebtedness that is recorded in the county
I that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
mama ^ - Date(month,day,year)
J Full resident ad of a (Il t(,(jnuu and street,city,state,and ZIP code)
T el/ .s ?a;.v(r cr 7.v,-, )ems rc,t) /N. 9 d V
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dly,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.